经肝动脉栓塞化疗联合调强放疗治疗局部进展期肝细胞癌的效果和安全性

Efficacy and safety of transcatheler-arterial chemoembolization(TACE)combined with intensity-modulated radiotherapy(IMRT)in the treatment of locally advanced hepatocellular carcinoma

目的 探讨经肝动脉栓塞化疗(TACE)联合调强放疗(IMRT)治疗局部进展期肝细胞癌的疗效及安全性。方法 收集2008年2月至2021年1月在武警河南省总队医院治疗的78例局部进展期肝细胞癌患者的临床资料,随访至2021年6月,失访7例;71例患者根据治疗方式分为单纯经肝动脉栓塞化疗组(TACE组) 32例和调强放疗联合经肝动脉栓塞化疗组(IMRT+TACE组) 39例。观察两组不同治疗方式Ⅱ级以上不良反应及客观缓解率(ORR)、疾病控制率(DCR)等近期疗效和疾病无进展生存期(PFS)情况。结果 Ⅱ级以上不良反应:肝功能损伤、肾功能损伤、心脏损伤、发热、恶性呕吐发生率TACE组和IMRT+TACE组分别为:25.0%(8/32)、6.3%(2/32)、9.4%(3/32)、31.2%(10/32)、65.7%(21/32)和25.6%(10/39)、7.7%(3/39)、10.3%(4/39)、33.3%(13/39)、66.6%(26/39),差异未见统计学意义(P>0.05);ORR、DCR及PFS TACE组和IMRT+TACE组分别为:53.1%(17/32)、78.1%(25/32)、9.5个月和64.1%(25/39)、87.2%(34/39)、13.2个月,差异有统计学意义(P <0.05)。结论 局部进展期肝细胞癌调强放疗联合经肝动脉栓塞化疗较单纯经肝动脉栓塞化疗Ⅱ级以上不良反应没有明显增加,调强放疗联合经肝动脉栓塞化疗较单纯经肝动脉栓塞化疗在疾病局部控制和PFS有明显的优势。

Objective To investigate the efficacy and safety of transcatheler-arterial chemoembolization( TACE) combined with intensity-modulated radiotherapy( IMRT) in the treatment of locally advanced hepatocellular carcinoma. Methods The clinical data of 78 patients with locally advanced hepatocellular carcinoma treated in Henan Armed Police Corps Hospital from February 2008 to January 2021 were selected. Up to June 2021,7 cases were lost;71 patients were divided into 32 cases in TACE group and 39 cases in IMRT + TACE group. The short-term efficacy and disease progression free survival( PFS) of the two groups were observed. Results The rate of adversereaction above grade Ⅱ of liver injure, renal injure, heart injure, fever and pernicious vomiting in TACE group and IMRT + TACE group were 25. 0 %( 8/32),6. 3 %( 2/32),9. 4 %( 3/32),31. 2%( 10/32),65. 7%( 21/32) and 25. 6%( 10/39),7. 7%( 3/39),10. 3%( 4/39),33. 3%( 13/39),66. 6%( 26/39),and the differences were not significant( P >0. 05). The ORR,DCR and PFS in TACE group and IMRT + TACE group were: 53. 1 %( 17/32),78. 1 %( 25/32),9. 5 month and 64. 1 %( 25/39),87. 2 %( 34/39),13. 2 month,and the differences were significant( P < 0. 05). Conclusions Intensity modulated radiotherapy combined with transcatheter arterial chemoembolization for locally advanced hepatocellular carcinoma has no significant increase in toxic and side effects above grade II compared with transcatheter arterial chemoembolization alone. Intensity modulated radiotherapy combined with transcatheter arterial chemoembolization has obvious advantages in local disease control and PFS compared with transcatheter arterial chemoembolization alone.